Clinical Medicine Insights. Case Reports最新文献

A case of spontaneous bilateral internal carotid artery dissection (ICAD) in a 36-year-old male, potentially linked to COVID-19, is reported. Initially presenting with excessive daytime sleepiness, an atypical symptom for ICAD, the patient lacked focal neurologic deficits. Diagnostic evaluation revealed severe stenosis and dissecting aneurysms in both carotid arteries. Treatment included anticoagulation, corticosteroid therapy, and subsequent endovascular stent placement. This case underscores the importance of considering ICAD as a potential complication of COVID-19, especially in patients with atypical symptoms. Further research is needed to understand the underlying mechanisms and optimize treatment strategies.

Background: Renal infarction is an uncommon complication of Blunt renal artery injury (BRAI) following abdominal trauma. Diagnosis of infarction is difficult and mostly delayed due to non-specific symptoms. Early diagnosis can lead to appropriate and effective treatment, which prevents further complication.

Case presentation: We report a case of 21-year-old man falling from a height of 9 m. A contrast-enhanced CT scan in the nephrogram phase showed no evidence of absorption in the right kidney and significantly decreased absorption in the left kidney. The pyelogram phase showed no secretion in the right kidney and decreased secretion in the left kidney suggesting segmental renal infarction. Subsequently, heparin infusion was initiated immediately. A follow-up contrast- enhanced abdominopelvic CT scan was performed after 1 month and showed no sign of infarction, and all laboratory tests were normal.

Conclusion: Contrast-enhanced abdominopelvic CT scan helps physicians diagnose the renal infarction immediately and start appropriate treatment. Treatment can vary from aggressive surgical procedures to observation and supportive care.

The accurate diagnosis of pathologies with obscure presentations requires comprehensive clinical evaluation, epidemiological context, and consideration of the patient's clinical or hospital course. In this case report, we describe a 30-year-old female receiving antituberculosis therapy who developed multiple signs and symptoms that were unexplained by any single diagnosis, including multiple rashes with different features. The patient was determined to have drug induced lupus with concomitant HIV infection. Physicians should consider the possibility of co-existing disease processes when a single unifying diagnosis that reconciles all aspects of the patient's presentation cannot be identified.

Pena-Shokeir Syndrome (PSS) is a rare autosomal recessive disorder characterized by dysmorphic features, camptodactyly, arthrogryposis, intrauterine growth restriction, polyhydramnios, and pulmonary hypoplasia. Two types of this syndrome have been defined, differentiated by distinct clinical and genetic features. PSS is a potentially life-threatening condition, with most cases expected to be diagnosed prenatally via ultrasound. Genetic counseling is crucial to inform parents about recurrence risks and management strategies for future pregnancies. We report a case of PSS in a dichorionic diamniotic (DCDA) twin pregnancy. Despite normal prenatal ultrasounds, 1 twin was diagnosed postnatally with severe craniofacial anomalies, limb deformities, and pulmonary complications, consistent with PSS. In contrast, the second twin exhibited normal growth and development, with no anomalies identified. To the best of our knowledge, this is the third reported case of PSS in a twin pregnancy and the second involving a normal co-twin. This case aims to contribute to the existing literature by detailing the unique dysmorphic and clinical findings associated with PSS and emphasizing the diagnostic challenges in twin pregnancies.

Introduction: Scabies is a parasitic skin condition, with crusted scabies (CS) being a severe and highly contagious variant characterized by thickened skin lesions and a high mite count. CS is typically associated with immunocompromised individuals but can also develop in those suffering from malnutrition, as malnutrition weakens immune responses and impairs skin integrity.

Case presentation: We report a case of CS in a 50-year-old malnourished male with no history of scabies or systemic disease, recently incarcerated. He presented with widespread itching, hyperkeratotic papules on the palms and soles, and secondary impetigo. The patient showed signs of malnutrition, with a BMI of 15.6 kg/m² and muscle wasting. Sarcoptes scabiei mites, eggs, and scybala were identified microscopically. The case was classified as Grade 3 CS. Treatment included two doses of ivermectin (8 mg) one week apart, 10% sulfur ointment, and benzyl benzoate soap. Follow-up was incomplete, highlighting challenges in managing socially vulnerable patients.

Discussion: This case emphasizes the importance of early recognition, accurate diagnosis, and effective treatment of CS, especially in settings with poor sanitation and overcrowding. The patient's malnutrition likely contributed to the severity of the condition, as compromised immunity can facilitate mite proliferation.

Conclusion: A holistic approach addressing malnutrition, sanitation, and patient education is crucial in managing CS in resource-limited settings.

Introduction: During the COVID-19 pandemic, incidence of brain abscesses is difficult to assess. Numerous studies reported benign and severe post SARS-CoV-2 vaccine side effects, including rare cases of brain abscesses associated with COVID-19 or Anti-SARS-CoV-2 vaccines. Here in, we report what we believe to be, up to date, the fourth known case in the medical literature of a streptococcus salivarius brain abscess, the first intra parenchymatous or supra-tentorial streptococcus salivarius brain abscess and also the first that occurs following an anti-SARS-CoV-2 vaccine.

Case presentation: We describe the case of a north african 63-year-old man with an unremarkable medical history except for recent anti-SARS-CoV-2 vaccinations. Following the administration of a third anti-SARS-CoV-2 booster vaccine, the patient developed neurological symptoms, including left hemiparesis, facial palsy, vertigo, and balance issues. Imaging studies revealed a right temporo-parietal lesion consistent with intracranial suppuration. Stereotaxic cerebral biopsy confirmed the presence of purulent content, indicating a brain abscess caused by multi-sensitive streptococcus salivarius.

Conclusion: Sepsis-induced immunodepression appears to be a consequence of severe inflammatory state, as it dysregulates leukocytes population and results in serious infections. A plausible hypothesis is that a previous stress such as anti-SARS-CoV-2 vaccination could lead to the development of a streptococcus salivarius septicemia. In light of the available evidence and research findings, no definitive conclusion can be drawn regarding any potential link between anti-SARS-CoV-2 vaccines and the physiopathology of sepsis-induced immunodepression.

Biliary tract carcinomas (BTC) are malignant epithelial neoplasms subdivided anatomically into: gallbladder carcinomas and carcinomas of the bile duct or cholangiocarcinomas (CCA); including intrahepatic, hilar/perihilar, and distal CCA. Adenocarcinoma accounts for the most common BTC (over 90% of all carcinomas), while other histological subtypes represent rarer forms including: poorly cohesive/signet ring cell carcinoma, which has a greater malignant potential than conventional BTC and a poorer prognosis. Only few cases have been reported in the literature to date. The positive diagnosis remains on histology. Herein, we describe a new case of poorly cohesive carcinoma of bile duct extending to the gallbladder in a 60 years old women with a fatal outcome, to raise awareness of this rare entity and to provide data for larger series.

In this paper, we present 2 patients with ST-elevation myocardial infarction in the course of Spontaneous Coronary Artery Dissection. The first patient, a female admitted with STEMI, was diagnosed with SCAD with intravascular imaging and treated with IVUS-guided PCI. In the second patient, a young male hospitalized due to angina and STEMI, SCAD was not identified initially, and the patient was treated conservatively. Based on these cases, we show different faces of the same disease that imply different diagnostics and management strategies. We draw attention to the fact that the disease affects not only young women without atherosclerotic risk factors and that it is not always possible to avoid generally not recommended invasive treatment and anticoagulant therapy. The paper also discusses the disease's pathophysiology and its diagnosis methods.

Introduction: Fever of unknown origin is one of the challenging medical conditions with a wide differential diagnosis.

Case presentation: We present a case of 16-year-old patient with Ewing sarcoma diagnosed with neoplastic fever.

Discussion: Neoplastic fever, which is caused by the tumor itself, is diagnosed when all other causes of fever have been ruled out. It occurs more frequently in hepatic, renal, and hematological cancers. After history and physical examination, a thorough individualized diagnostic approach is required. Removing the underlying cause of fever when feasible and symptomatic relief with NSAIDS are the primary therapeutic approaches.

Conclusion: Fever is common in patients with cancer and it can be due to infectious and non-infectious causes. After excluding all potential causes, neoplastic fever is diagnosed.

Tuberous sclerosis complex (TSC) is a rare multisystemic neurocutaneous syndrome with a wide spectrum of clinical manifestations. We present a case of a 14-year-old adolescent female who presented with a history of facial angiofibromas since the age of 8 months. Physical examination was remarkable for multiple angiofibromas on the face, and other multiple cutaneous manifestations of TSC. MRI of the head, and abdomen revealed cortical tubers, multiple bilateral periventricular and subependymal nodular lesions, calcifications, and bilateral kidney enlargement with multiple bilateral renal angiomyolipomas of varying sizes in a background of bilateral polycystic kidneys, MRI of the chest was unremarkable. A diagnosis of TSC was made using the clinical diagnostic criteria which consist of major and minor features. A diagnosis using genetic studies could not be made due to a lack of resources. Management was multidisciplinary and regular monitoring every 6 months will be required to monitor disease progression and manage complications as they arise. This case illustrates the multidisciplinary approach needed to address the diverse clinical manifestations of TSC and the diagnostic challenges, treatment limitations, and psychological impact of TSC in low-resource settings like Zambia where access to advanced therapies is limited.